Effects of the duration of the habituation period on energy intakes from low and high energy density gruels by Burkinabè infants living in free conditions

The present study was carried out in Ouagadougou (Burkina Faso) with the aim of determining if the duration of the habituation period (1, 5 or 10 days) to low and high energy density gruels affected the amounts consumed or the energy intakes from gruels consumed by 6-9-month-old infants. Thirty infants were chosen randomly among the eligible children in the study area and randomly assigned to two groups (S1 and S2). Each infant was given successively for 10 consecutive days two experimental gruels, each type of gruel being fed twice a day. The 15 infants in group S1 received low energy density gruel (G1) in the first period and high energy density gruel (G2) in the second, and the 15 infants in group S2 received G2 in the first period and G1 in the second. The two periods of 10 days were separated by 4 days during which the infant received his or her usual foods. The intakes of experimental gruels and other complementary foods were measured on days 1, 5 and 10 of each period. Whatever the type of gruel, the 10-day period of habituation did not result in an increase in the amounts consumed or in the energy intakes from these gruels. The amounts of G1 consumed on day 5 were significantly higher than those of G2 (9.0 vs 6.8 g/kg/meal; p = 0.044). Energy intakes from G2 were significantly higher than those from G1 on days 1 (28.8 vs 18.0 kJ/kg/meal; p = 0.0002), 5 (28.8 vs 19.2 kJ/kg/meal; p = 0.002) and 10 (25.9 vs 15.5 kJ/kg/meal; p = 0.0004). Daily frequencies of breastfeeding (approximately 5.6), water drinking (approximately 3.7) and meals with foods other than experimental gruels were relatively high and did not vary with the duration of the habituation period or the type of gruels. Whatever the type of gruel, the increase in the duration of the habituation period did not increase the amount consumed or energy intakes. The study confirmed that consumption of high energy density gruels led to a 60% increase in energy intakes in comparison with the consumption of low energy density gruels.     

Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods

We assessed the adequacy of nutrient intakes of 135 rural Bangladeshi breast-fed infants 6-12 mo of age and examined nutritional trade-offs due to possible displacement of breast milk by complementary foods. Observers completed 12-h daytime measurements of breast milk and complementary food intakes; data for the previous 12 h were obtained from maternal recall, yielding estimates of total 24-h intakes. On average, infants were mildly wasted (mean +/- SD weight-for-length Z-score = -0.92 +/- 0.88) and moderately stunted (length-for-age Z-score = -1.49 +/- 0.96). Total energy intakes at 6-8 and 9-12 mo were 88 and 86% of absolute energy requirements (kJ/d), 106 and 105% of requirements per kg body weight, and 97 and 94% of requirements per kg median weight-for-length, respectively. Breast milk contributed 78% of energy intake at 6-8 mo and 75% at 9-12 mo. Mean meal frequency and energy density of complementary foods were generally consistent with recommendations, but only small amounts of food were offered. Nevertheless, only 72% of the food energy offered was consumed. Total energy intake was positively correlated with meal frequency, quantity consumed per meal, and energy intake from breast milk, but not with energy density of complementary foods. Energy intake from complementary foods was inversely related to energy intake from breast milk. The diets fell short of recommended intakes for numerous vitamins and minerals. We conclude that although greater intakes of complementary foods were associated with higher total energy intake, micronutrient intake remained low due to the low micronutrient density of the complementary foods consumed and the partial displacement of breast milk.     

Effects of energy density and sweetness of gruels on Burkinabe infant energy intakes in free living conditions

In free living conditions, 24 breastfed infants, aged 6 to 10 months, were given successively five experimental gruels to study the effect of energy density (ED) and sweetness (sweet taste) on energy intakes (EI). Four gruels (G0, G1, G9 and G20) were prepared with experimental flours which were composed of the same local ingredients and which contained different levels of sucrose. The fifth gruel (GC) was prepared with an industrial flour. G0 had an average ED of 45 kcal/100 g (189 kJ/100 g) and the other gruels an average ED of 110 kcal/100 g (461 kJ/100 g). Although the sugar contents of the flours were 1% for G1, 9% for G0 and G9 and 20% for G20, because of flour composition and gruel dry matter content, the gruel G1 had the same sweetness as G0, G20 the same sweetness as GC and G9 a sweetness between that of G1 and G20. The results show that the amounts of G0 consumed were significantly higher than those of high ED gruels (7.84 for G0 vs 6.12, 5.63, 4.46, 4.72 g/kg body weight/meal, respectively for G20, G9, G1 and GC, P < 0.05). However, EI from high ED gruels were significantly (P < 0.001) higher than those from G0 (6.65, 6.10, 4.86, 4.83 kcal/kg/meal, respectively for G20, G9, G1 and GC vs 3.46 for G0). Energy intakes from G9 and G20 gruels were not significantly different but were significantly higher than those from GC and G1 (P < 0.001). So, consumption of sweet gruels with high ED and composed of local ingredients increased, at least by 76%, the EI from gruels in comparison with those from low ED gruels, but the amounts consumed by the infants remained too low to cover more than 15% of their daily total energy needs.     

Effects of energy density and sweetness of gruels on Burkinabe infant energy intakes in free living conditions

In free living conditions, 24 breastfed infants, aged 6 to 10 months, were given successively five experimental gruels to study the effect of energy density (ED) and sweetness (sweet taste) on energy intakes (EI). Four gruels (G0, G1, G9 and G20) were prepared with experimental flours which were composed of the same local ingredients and which contained different levels of sucrose. The fifth gruel (GC) was prepared with an industrial flour. G0 had an average ED of 45 kcal/100 g (189 kJ/100 g) and the other gruels an average ED of 110 kcal/100 g (461 kJ/100 g). Although the sugar contents of the flours were 1% for G1, 9% for G0 and G9 and 20% for G20, because of flour composition and gruel dry matter content, the gruel G1 had the same sweetness as G0, G20 the same sweetness as GC and G9 a sweetness between that of G1 and G20. The results show that the amounts of G0 consumed were significantly higher than those of high ED gruels (7.84 for G0 vs 6.12, 5.63, 4.46, 4.72 g/kg body weight/meal, respectively for G20, G9, G1 and GC, P < 0.05). However, EI from high ED gruels were significantly (P < 0.001) higher than those from G0 (6.65, 6.10, 4.86, 4.83 kcal/kg/meal, respectively for G20, G9, G1 and GC vs 3.46 for G0). Energy intakes from G9 and G20 gruels were not significantly different but were significantly higher than those from GC and G1 (P < 0.001). So, consumption of sweet gruels with high ED and composed of local ingredients increased, at least by 76%, the EI from gruels in comparison with those from low ED gruels, but the amounts consumed by the infants remained too low to cover more than 15% of their daily total energy needs.     

Breast milk intake is not reduced more by the introduction of energy dense complementary food than by typical infant porridge

The effect of different energy densities of complementary foods on breast milk consumption is not well understood. In this study, we tested the hypothesis that provision of fortified spread (FS), a micronutrient fortified, energy-dense (22 kJ/g), ready-to-use food, to Malawian infants would not decrease their breast milk intake more than a traditional corn + soy blended flour (CSB). Forty-four healthy 6-mo-old infant and mother pairs were enrolled in a prospective, parallel group, investigator-blinded, randomized controlled complementary feeding trial. Infants were randomized to receive 25 g/d of FS, 50 g/d of FS, or 72 g/d of CSB. The primary outcome was the difference in breast milk intake after 1 mo of complementary feeding as measured by the dose-to-mother deuterium oxide dilution technique. Outcomes were compared using repeated measures ANOVA. A total of 41 mother-infant pairs completed the study. At enrollment, 88% of the infants had received corn porridge. At baseline, the infants consumed 129 +/- 18 g.kg body wt(-1) x d(-1) (mean +/- SD) of breast milk. After 1 mo of complementary feeding with 25 g/d FS, 50 g/d FS, or 72 g/d CSB, their breast milk consumption was 115 +/- 18 g.kg body wt(-1) x d(-1), a significant reduction; however, the effects of the complementary foods did not differ from one another (F-value model = 4.33, P = 0.0008 for effect of time and P = 0.69 for effect of type of food). The results suggest that complementary feeding of Malawian infants with FS has the same effect on their breast milk intake as complementary feeding with traditional CSB porridge.     

Nutritional status of infants and young children and characteristics of their diets

Adoption of the recommended breast-feeding and complementary feeding behaviors and access to the appropriate quality and quantity of foods are essential components of optimal nutrition for infants and young children between ages 6 and 24 mo. Iron, zinc and vitamin B-6 are deficient in complementary food diets in Bangladesh, Ghana, Guatemala, Mexico and Peru. Low intakes of iron are consistent with a high prevalence of anemia seen in this age group. The adequacy of observed intakes for calcium, vitamin A, thiamin, folate and vitamin C depends on the age range in question and the set of requirements used in the assessment. The lipid content of many complementary food diets is low. In addition to providing essential fatty acids, lipids are needed for the absorption of fat-soluble vitamins and also enhance the texture, flavor and aroma of foods, which may lead to increased intake. The relative roles of palatability, micronutrient deficiency and morbidity-induced anorexia in the appetite of infants and young children are not known. However, even among children who were growth retarded and had a total energy deficit compared with requirements, up to 25% of food offered was not consumed. This indicates that dietary quality rather than quantity is the key aspect of complementary food diets that needs to be improved. Targeted fortification or the production of complementary foods fortified with micronutrients and of an adequate macro- and micronutrient composition is one approach to help meet nutritional requirements during the vulnerable period of 6-24 mo.     

Food Sources of Total Energy and Nutrients among U.S. Infants and Toddlers: National Health and Nutrition Examination Survey 2005–2012

Understanding the dietary intakes of infants and toddlers is important because early life nutrition influences future health outcomes. The aim of this study was to determine the dietary sources of total energy and 16 nutrients in a nationally representative sample of U.S. infants and toddlers aged 0–24 months. Data from the 2005–2012 National Health and Nutrition Examination Survey were analyzed. Dietary intake was assessed in 2740 subjects using one 24-h dietary recall. The population proportion was used to determine the contribution of foods and beverages to nutrient intakes. Overall infant formulas and baby foods were the leading sources of total energy and nutrients in infants aged 0–11.9 months. In toddlers, the diversity of food groups contributing to nutrient intakes was much greater. Important sources of total energy included milk, 100% juice and grain based mixed dishes. A number of foods of low nutritional quality also contributed to energy intakes including sweet bakery products, sugar-sweetened beverages and savory snacks. Overall non-flavored milks and ready-to-eat cereals were the most important contributors to micronutrient intakes. In conclusion this information can be used to guide parents regarding appropriate food selection as well as inform targeted dietary strategies within public health initiatives to improve the diets of infants and toddlers.     

Nutrient intake in the United States during the first 12 months of life

Nutrient intakes of 463 infants ranging in age from 1 week to 12 months from the Nationwide Food Consumption Survey 1977-78 were evaluated according to different foods (milk and milk products, noniron-fortified formula, iron-fortified formula, infant cereal, commercial baby foods, and table foods). Breast-fed infants and infants fed a combination of cow's milk and formula were excluded. Results indicated that iron was the nutrient most often consumed in amounts less than the RDA. Infants fed a diet that included either cow's milk or noniron-fortified formula had a median iron intake less than the recommended allowance. In comparison, infants who were fed an iron-fortified formula had a median iron intake well above the RDA. The relative proportion of iron derived from different foods is discussed.     

Dietary sodium intake of infants fed commercially prepared baby food and table food

Sodium intake of infants varies widely with the type of food consumed. However, few reports are available describing the nutrients, including sodium values, of dietary intakes of infants receiving supplemental foods. The purpose of this study was to determine the sodium, energy, and nutrient values of diets for infants from low-income families participating in the WIC program. The sample consisted of 306 infants, aged 4 through 7 months, who were seen in well-child clinics. Approximately 200 of the infants were reportedly fed commercially prepared baby food as the only solid food; 55 received 50% or more of their energy from table foods. The dietary intakes of infants receiving supplemental foods and consuming commercially prepared baby foods included significantly less sodium than the intakes of infants fed primarily table foods. As a group, all infants met the RDAs for most nutrients but had higher sodium values than reported by other researchers. The group of infants for whom consumption of table foods was reported had values above the acceptable range for sodium primarily because the caregivers failed to provide low-sodium, nutrient-dense, supplemental foods in the quantities prescribed but instead substituted sodium-dense meat and vegetable products.     

Commercial Baby Food Consumption and Dietary Variety in a Statewide Sample of Infants Receiving Benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children

Dietary variety and exposure to fruits and vegetables in infancy have been associated with nutritional benefits and later acceptance of these foods. The objective of this study was to examine the prevalence of fruit and vegetable commercial baby food consumption and its relation to dietary variety during infancy. A cross-sectional statewide telephone survey of 733 Maryland mothers and infants receiving benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was conducted between July 2004 and July 2005. A 24-hour dietary recall was examined to assess infant dietary variety. Among infants from birth to age 5 months, 54% had consumed complementary foods in the past 24 hours; 60% received commercial baby foods. Among infants aged 6 to 12 months, 98% had consumed complementary foods in the past 24 hours; 81% received commercial baby foods. In the latter age range, the average daily number of different types of fruits and vegetables consumed was 1.5±1.2, range 0 to 6). In a multivariate model, infants aged 6 to 12 months who received commercial baby foods consumed a greater variety of fruits and vegetables (β=.54, 95% confidence interval 0.26-0.84; P<0.001) than infants who did not, characterized by a diet that was lower in white potatoes (14% vs 22%) and higher in dark-green (6% vs 5%) and deep-yellow (35% vs 10%) vegetables. Commercial baby food is consumed by a majority of WIC infants, although many mothers introduce it before the recommended age of 6 months. Among infants aged 6 to 12 months, commercial baby food is associated with dietary variety in fruits and vegetables. By encouraging consumption of fruits and vegetables after 6 months of age, either through the provision of commercial baby foods and/or education and resources related to the preparation of fruits and vegetables for infants, WIC can increase dietary variety and appropriate introduction of complementary foods among infants.     

Significance of fortified beverages in the long-term diet of German children and adolescents: 15-year results of the DONALD Study

Fortified beverages and instant drinks are the most frequently consumed fortified products in children and adolescents in Germany. However, little is known about the contribution of these products to micronutrient intake. Between 1986 and 2000, consumption of fortified food (total and the subgroup of fortified beverages) and time trends in energy and micronutrient intake were assessed on the basis of 3 day-weighed dietary records (n = 4358) of males and females between the ages of 2 and 14 years (n = 398/408) enrolled in the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study). As percentage of recent references for micronutrient intake, a significant increase in intake from fortified beverages was observed for calcium (from 1 to 3%), iron (3 to 4%), vitamin A (5 to 15%), and vitamin C (5 to 60%). Significant increases in intakes were only observed from 1995-1997 for vitamin E, folate, and niacin (all 5 to 15-25%), vitamin B1 and B2 (both 10-15 to 25-30%) and vitamin B6 (20 to 55%). Thereafter significant decreases were found. Among the fortified beverages, juice was the most important for micronutrient intake, followed by soft drinks (calcium, vitamin A, E, C, folate, niacin) or by instant beverages (energy, iron, vitamin B1, B2, B6). Significant linear and nonlinear time trends in micronutrient intakes from fortified food and fortified beverages were observed in German children and adolescents.     

Effect of timing of introduction of complementary foods on iron and zinc status of formula fed infants at 12, 24, and 36 months of age

OBJECTIVE: The timing of introduction of complementary food to an infant's diet is variable throughout the world. Our objective was to determine whether early introduction of complementary foods affects iron and zinc status of formulated infants at 12, 24, and 36 months of age. DESIGN: A randomized, prospective trial was conducted. Infants were randomly assigned to receive either a) early introduction (at 3 to 4 months of age) of commercially prepared or parent's choice of complementary foods; or b) late introduction (at 6 months of age) of commercially prepared complementary foods or parent's choice of complementary foods. In addition to complementary foods, infants were fed commercial infant formula as recommended by their pediatrician. Hemoglobin, mean corpuscular volume, and serum ferritin and zinc concentrations were determined at 12, 24, and 36 months of age. Three-day diet diaries were completed at 3, 6, 12, 18, 24, 30, and 36 months of age. SUBJECTS/SETTING: One hundred seventy-five infants younger than 3 months were recruited by mailings to parents in the Cincinnati area. Of these, 172 were enrolled, 90 in the early-introduction group and 82 in the late-introduction group. One hundred thirty-three infants (n = 67 in the early, n = 66 in the late group) completed the study. STATISTICAL ANALYSES PERFORMED: Student t test and regression analyses were used to determine whether there were group differences and whether there was a relationship between serum parameters and dietary intake. RESULTS: Infants fed complementary foods early had significantly greater iron intakes until 6 months of age; however, there were no differences in the iron status parameters (ferritin, hemoglobin, and mean corpuscular volume) at 12, 24, or 36 months of age. The early introduction group consumed slightly less zinc than the late introduction group at 5 months (4.4 vs 4.8 mg/day, P < .01) and 6 months (4.4 vs 4.7 mg/day, P < .01). At all other times there were no differences between the early and late group in zinc intakes. The serum zinc concentration was not associated with dietary zinc. Both groups had normal serum zinc concentrations at 12, 24, and 36 months and there were no differences between groups. APPLICATIONS/CONCLUSIONS: The iron and zinc status of infants in this study was not influenced by the timing or type of complementary foods introduced. However, the infants were formula fed and the mean iron and zinc intakes that were equal or greater than the Recommended Dietary Allowances for the first 6 months of age.     

A comparison of nutrient intake between infants and toddlers with and without cystic fibrosis

OBJECTIVE: To compare the micronutrient and energy intake of infants and toddlers with cystic fibrosis (CF) to the intake of matched control children and dietary reference index (DRI) levels. DESIGN: A two-group comparison study. Nutrient and energy intakes were measured via 3-day diet diaries. Anthropometric data were collected within 1 week of study enrollment. SUBJECTS/SETTING: A clinical sample of 35 infants and toddlers with CF (mean=18.6, SD=8.1 months) matched to a community sample of 34 healthy controls. STATISTICAL ANALYSES PERFORMED: Children with CF and controls were compared on anthropometric and nutrient data using independent sample t tests. Mean nutrient and energy intake for children in each group were compared with the age-appropriate DRI for targeted nutrients using percentages. RESULTS: Children with CF and controls were similar on measures of growth (height, weight, or weight-for-height percentile). Four children with CF were at or below the 10th percentile for weight-for-height, compared with one control child. Children with CF and controls did not differ on average daily protein, calcium, zinc, and energy intake. Overall, children met or exceeded DRI levels for nutrient intakes. A notable exception was iron, for which mean intakes were lower for control children. Toddlers with CF consumed only 89% of the RDA per day for energy. APPLICATIONS/CONCLUSIONS: Infants and toddlers with CF are likely obtaining adequate micronutrient intakes from food. Interventions to increase total energy intake in infants and toddlers with CF are needed. Dietitians may want to focus more on calorie intake and percent calories from fat than on micronutrient intake in their nutrition counseling in young children with CF.     

Effects of energy density and feeding frequency of complementary foods on total daily energy intakes and consumption of breast milk by healthy breastfed Bangladeshi children

BACKGROUND: Information is needed on the minimum energy density and feeding frequency of complementary foods that can provide adequate energy intakes (EIs) for healthy breastfed children. OBJECTIVES: The objectives of the study were to evaluate the effects of various energy densities and feeding frequencies of complementary foods on EI from these foods, breast milk consumption, and total EI from both sources. DESIGN: During 9 separate, randomly ordered dietary periods lasting 3-6 d each, we measured intakes of food and breast milk by 18 healthy breastfed children 8-11 mo of age who, 3, 4, or 5 times/d, were fed porridge with a coded energy density of 0.5, 1.0, or 1.5 kcal/g. Food intake was measured by weighing the feeding bowl before and after meals, and breast milk intake was measured by test weighing. RESULTS: The mean amounts of complementary foods consumed were inversely related to their energy density and positively related to the number of meals/d (P < 0.001 for both); EIs from foods were positively related to both factors. Breast milk intake decreased slightly but progressively, with greater energy density and feeding frequency of complementary foods; total EIs (kcal/d) increased in relation to both factors (P < 0.001 for both). CONCLUSIONS: The energy density and feeding frequency of complementary foods affect infants' total daily EI and breast milk consumption. Recommendations can be developed for the appropriate combinations of these dietary factors that are compatible with adequate EI, although longer-term effects of complementary feeding practices on breast milk intake and breastfeeding duration need further community-based studies.     

Differences in weaning practice, food and nutrient intake between breast- and formula-fed 4-month-old infants in England

BACKGROUND: Breastfed infants may grow more slowly in the second half of infancy than formula-fed infants, differences in weaning practice may contribute. METHODS: Dietary intakes of 4-month-old infants have been investigated cross-sectionally. Diet was assessed using a structured 1-day un-weighed dietary record in 852 white singletons (72% of those invited) from a random sub-sample of infants taking part in Avon Longitudinal Study of Parents and Children. Nutrient intakes of formula-fed infants were compared by sex and with UK reference values. Estimated mean energy and nutrient intakes, mean bodyweight and daily quantities of food consumed were compared by weaning practice. RESULTS: In formula-fed infants mean energy intakes and intakes of most nutrients were adequate. There were significant differences in intakes of most nutrients by weaning practice; however, mean energy intake and body weight of breastfed infants was similar to formula-fed infants. Infants given formula milk were less likely to consume vegetables and fruit, and more likely to consume commercial infant drinks, compared with infants who were breastfed. In breastfed infants breast milk intake was lower if solids were given (905 g versus 818 g; P = 0.01); however, nutrient intake was not compromised. In formula-fed infants milk intake was not different in those having solids compared to those having milk only (810 g versus 795 g; P = 0.649). CONCLUSIONS: Differences in weaning practice and patterns of food consumption were seen between breast- and formula-fed infants, these may contribute to later growth differences.     

Overestimation of infant and toddler energy intake by 24-h recall compared with weighed food records

BACKGROUND: Twenty-four-hour dietary recalls have been used in large surveys of infant and toddler energy intake, but the accuracy of the method for young children is not well documented. OBJECTIVE: We aimed to determine the accuracy of infant and toddler energy intakes by a single, telephone-administered, multiple-pass 24-h recall as compared with 3-d weighed food records. DESIGN: A within-subjects design was used in which a 24-h recall and 3-d weighed food records were completed within 2 wk by 157 mothers (56 non-Hispanic white, 51 non-Hispanic black, and 50 Hispanic) of 7-11-mo-old infants or 12-24-mo-old toddlers. Child and caregiver anthropometrics, child eating patterns, and caregiver demographics and social desirability were evaluated as correlates of reporting bias. RESULTS: Intakes based on 3-d weighed food records were within 5% of estimated energy requirements. Compared with the 3-d weighed food records, the 24-h recall overestimated energy intake by 13% among infants (740 +/- 154 and 833 +/- 255 kcal, respectively) and by 29% among toddlers (885 +/- 197 and 1140 +/- 299 kcal, respectively). Eating patterns (ie, frequency and location) did not differ appreciably between methods. Macronutrient and micronutrient intakes were higher by 24-h recall than by 3-d weighed food record. Dairy and grains contributed the most energy to the diet and accounted for 74% and 54% of the overestimation seen in infants and toddlers, respectively. Greater overestimation was associated with a greater number of food items reported by the caregiver and lower child weight-for-length z scores. CONCLUSIONS: The use of a single, telephone-administered, multiple-pass 24-h recall may significantly overestimate infant or toddler energy and nutrient intakes because of portion size estimation errors.     

A three-part, mixed-effects model to estimate the habitual total vitamin D intake distribution from food and dietary supplements in Dutch young children

Statistical modeling of habitual micronutrient intake from food and dietary supplements using short-term measurements is hampered by heterogeneous variances and multimodality. Summing short-term intakes from food and dietary supplements prior to simple correction for within-person variation (first add then shrink) may produce estimates of habitual total micronutrient intake so badly biased as to be smaller than estimates of habitual intake from food sources only. A 3-part model using a first shrink then add approach is proposed to estimate the habitual micronutrient intake from food among nonsupplement users, food among supplement users, and supplements. The population distribution of habitual total micronutrient intake is estimated by combining these 3 habitual intake distributions, accounting for possible interdependence between Eq. 2 and 3. The new model is an extension of a model developed by the USA National Cancer Institute. Habitual total vitamin D intake among young children was estimated using the proposed model and data from the Dutch food consumption survey (n = 1279). The model always produced habitual total intakes similar to or higher than habitual intakes from food sources only and also preserved the multimodal shape of the observed total vitamin D intake distribution. This proposed method incorporates several sources of covariate information that should provide more precise estimates of the habitual total intake distribution and the proportion of the population with intakes below/above cutpoint values. The proposed methodology could be useful for other complex situations, e.g. where high concentrations of micronutrients appear in episodically consumed foods.     

An Assessment of the Impact of Fortification of Staples and Condiments on Micronutrient Intake in Young Vietnamese Children

Targeted fortification programs for infants and young children are an effective strategy to prevent micronutrient deficiencies in developing countries, but the role of large-scale fortification of staple foods and condiments is less clear. Dietary modeling in children aged 6–60 months was undertaken, based on food consumption patterns described in the 2009 national food consumption survey, using a 24-h recall method. Consumption data showed that the median intake of a child for iron, vitamin A and zinc, as a proportion of the Vietnamese Recommended Dietary Allowance (VRDA), is respectively 16%–48%, 14%–49% and 36%–46%, (depending on the age group). Potential fortification vehicles, such as rice, fish/soy sauces and vegetable oil are consumed daily in significant amounts (median: 170 g/capita/day, 4 g/capita/day and 6 g/capita/day, respectively) by over 40% of the children. Vegetable oil fortification could contribute to an additional vitamin A intake of 21%–24% of VRDA recommended nutrient intake, while fortified rice could support the intakes of all the other micronutrients (14%–61% for iron, 4%–11% for zinc and 33%–49% of folate requirements). Other food vehicles, such as wheat flour, which is consumed by 16% of children, could also contribute to efforts to increase micronutrient intakes, although little impact on the prevalence of micronutrient deficiencies can be expected if used alone. The modeling suggests that fortification of vegetable oil, rice and sauces would be an effective strategy to address micronutrient gaps and deficiencies in young children.     

Feeding practices and factors contributing to wasting, stunting, and iron-deficiency anaemia among 3-23-month old children in Kilosa district, rural Tanzania

Infants in Tanzania are particularly vulnerable to under-nutrition during transition from breastmilk (as the only source of nourishment) to solid foods. A cross-sectional study was undertaken in Kilosa district in Tanzania to determine the feeding practices and the extent of wasting, stunting, and iron-deficiency anaemia. The study was done in two stages: in the first stage, a 24-hour dietary assessment was conducted to identify the type of complementary foods given and the eating habits according to age for 378 children aged 3-23 months. In the second stage, a progressive recruitment of 309 infants aged six months was made to measure weight, length, haemoglobin (Hb) concentration, zinc protoporphyrin concentration, and malaria parasitaemia. Birth-weight, the potential contributing factor to under-nutrition and iron-deficiency anaemia, was obtained from the children's clinic cards. The 24-hour dietary assessment revealed that children consumed mainly a thin porridge prepared from maize flour as complementary food. Carbohydrates contributed most energy (on average 69%), followed by fats (18.6%) and protein (on average 12.1%). The complementary food co-vered only 15%, 20%, and 27% of the recommended iron intake for children aged 6-8, 9-11 and 12-23 months respectively. The mean Hb concentration was 9.3 +/- 1.9 g/dL, 68% of the infants were moderately anaemic (7 < or =11 g/dL), and about 11% were severely anaemic with Hb below 7 g/dL, while 21% were non-anaemic Hb (> or =11 g/dL). Equally, the mean zinc protoporphyrin concentration was 10.0 +/- 6.2 microg/g Hb, and 76% of the infants were iron-deficient (>5 microg/g Hb). The prevalence of stunting was 35%, while wasting was only 1.3%. Low birth-weight and low body mass index of mothers were the strong predictors of stunting, whereas low birth-weight and iron-deficiency were the strong predictors of anaemia. The prevalence of malaria parasitaemia was high, affecting 50% of the infants. Having malaria was the only independent predictor associated with stunting, anaemia, and iron-deficiency. There is an urgent need to improve tradi-tional complementary foods in the studied community in terms of energy density, amount of fat in the diet, and bioavailability of macro and micronutrients.     

Use of the net metabolizable energy values for labeling of infant formulas and foods—potential issues

The use of net metabolizable energy (NME) rather than metabolizable energy (ME) to determine energy values for food labeling has been suggested. A review was undertaken to determine issues that might arise if NME were applied to infant formulas and foods for infants.Both ME and NME factors derived from adult studies appear to be reasonably applicable to infants. Use of NME rather than ME values decreased the apparent energy density of human milk by about 4%; that of infant formulas, 4–6%. Even though the regulatory requirements for upper and lower limits of nutrients in infant formulas are expressed per 100 kJ or per 100 kcal, few significant issues would be expected based on a change in the declared energy content of this magnitude. Energy content of representative baby foods decreased 2–9%. The regulatory implications of using NME are at least a requirement to relabel virtually all products.The use of NME as it relates to selection of a healthy diet for infants, scientific validity, comparability of food energy values and requirements, interproduct comparisons and facilitation of trade are briefly addressed. It is recommended that factors used to calculate food energy in infant formula and foods for infants and small children be consistent with those used for other foods.